Overseas visitors who need healthcare while in the United Kingdom may not be entitled to free healthcare from the National Health Service.
The Department of Health charging regulations places a legal obligation on NHS trusts to establish whether a person is an overseas visitor to whom charges apply, or whether they are exempt from charges.
To carry out these assessments, UCLH has a dedicated Overseas and Eligibility team who specialise in assessing patients to establish whether a patient is liable for charges or if an exemption applies. This may involve asking the patient to provide documents to prove or support entitlement. Patients who are assessed as not entitled to free care will be required to pay for their treatment and will be asked to make an upfront payment.
It is the responsibility of the patient to provide evidence, when requested, to demonstrate that they are entitled to free NHS treatment. When evidence is not provided, treatment will be charged for.
If you are unsure of your entitlement or status – please contact the Overseas Visitors Officers at 0203 447 8348 or email firstname.lastname@example.org who will be happy to help you.
If you are travelling from a European country to the UK you will need to show a valid EHIC or Provisional Replacement Certificate otherwise you will have to pay for your care directly. You will also be asked to provide the following:
- a copy of your passport
- your full address abroad
The EHIC must be produced (or a provisional replacement certificate) prior to discharge from the hospital or prior to an outpatient appointment, or you will be liable to pay all fees associated with your care and claim your care back through your home country.
The EU Regulations apply to all countries within the European Economic Area, which is made up of the member states of the EU:
Austria, Belgium, Bulgaria, Croatia, Cyprus (Southern), Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, plus Iceland, Liechtenstein, Norway and Switzerland.
Please note that your EHIC does not apply if you are having elective planned treatment. You will need to obtain an E112/S2 from your local Health Authority in your country of origin prior to an appointment being given in the UK. In the event, elective planned treatment is provided prior to receipt of an E112/S2, you will be charged for your treatment.
The UK has reciprocal healthcare agreements with the following non-European Economic Area countries (EEA):
Anguilla, Australia, Bosnia and Herzegovina, British Virgin Islands, Falkland Islands, Faroe Islands, Gibraltar, Isle of Man, Jersey, Kosovo, Macedonia, Montenegro, Montserrat, New Zealand, Serbia, St Helena, Turks and Caicos Islands.
Overseas visitors who can present evidence that they are nationals, citizens or lawful residents of one of these countries may be treated as exempt from charges in respect of treatment that the relevant agreement entitles them to. Generally, only immediate medical treatment is to be provided free of charge, to allow the overseas visitor to return home for other needs. Also, the agreements do not usually apply when the person has travelled to the UK for the purpose of obtaining healthcare.
Assessment of eligibility under reciprocal or bilateral arrangements can be complex so please contact the Overseas team for advice.
Please note that reciprocal and bilateral agreements do not apply if you are having elective planned treatment or treatment that can be carried out in your country of origin.
If you are liable for the charges associated with your care, you may choose to use your travel insurance or health insurance to fund your care. If you have insurance cover, it is your responsibility to contact the company to gain a ‘letter of guarantee’ and authorisation numbers from your insurers authorising your treatment.
You should be aware that under paragraphs 320(22) and 322(12), and 3.14 of Appendix V, of the Immigration Rules a person with outstanding debts of over £500 for NHS treatment that is not paid within two months of invoicing, may be denied a further immigration application to enter or remain in the UK.
In the absence of prompt full settlement or a reasonable repayment schedule, non-clinical information relating to this debt is provided routinely to the Home Office and may be used by the Home Office to apply the above Immigration Rules. The information will remain active for the purpose of the above rules until the debt is settled and a record of the settled debt will also be retained, both subject to normal limitation periods.
In the event that you may seek entry to the UK or make an advance immigration application after settling an NHS debt in the previous two months, you are advised to retain and carry evidence of payment for potential examination by Home Office officials.
Frequently Asked Questions (FAQ)
The NHS is a state-funded organisation which provides free hospital treatment to people who are legally living in the UK on a permanent basis. If you are not ordinarily resident in the UK, you may have to pay for your hospital treatment, even if you have a British passport, or have paid National Insurance contributions and taxes in this country in the past.
In order to receive free hospital treatment, you will need to provide evidence that you are legally living within the UK. All patients admitted to this hospital, whatever their nationality and living status, may be required to provide correct information when registering their details. If you are living in the UK on a settled basis then you should be prepared to provide evidence. Examples of acceptable documents can be found below.
You will not be charged for treatment you receive in A&E. However, if you are admitted or transferred to another ward, you may have to pay.
There are a number of circumstances under which you could be entitled to free healthcare:
- If you are visiting the UK and you normally live in a country that has a bilateral healthcare agreement with the UK, you might be entitled to free healthcare if you become unwell during your visit to the UK.
- If you are visiting the UK and you normally live in a country that is a member of the European Economic Area healthcare arrangement, you will be entitled to free healthcare, provided that you have a valid European Health Insurance Card (EHIC). This card does not entitle you to pre-planned treatment – only emergency treatment.
- If you have come from abroad to take up employment or studies in the UK, you might be entitled to free hospital treatment. However, it will not be enough to show your ‘right to work’. You need to be able to show evidence that you are actually working for a UK-based employer. If you are in full-time study, you need to be able to show that you are attending a full-time course of not less than six months duration.
- If you are a refugee or an asylum seeker whose formal application to the UK Border Agency is still being considered, you will not have to pay hospital charges. A refugee is someone who has been granted asylum in this country. If you are a refugee or an asylum seeker you will still have to pay for all prescribed medications.
The only person who can formally advise whether you are eligible for NHS treatment is a UCLH Overseas Officer. If a doctor or nurse tells you that you do not have to pay, they may be referring to the treatment you receive in the Emergency Department (sometimes also known as Accident & Emergency or Casualty Department) only.
The Overseas Visitors Team (contact details below) can provide you with more detailed information if you are unsure whether you are entitled to free hospital treatment.
You will be charged for any treatment given to you, by any member of staff in any of our services, both in the hospital or in the community. Exceptions may apply under certain circumstances, but we will discuss this with you if it applies to you.
If a patient states that they cannot afford to pay for their treatment, the Finance Department may be able to offer arrangements for the patient to pay in instalments in some circumstances. Charges will not be waived. Patients will be given details of how to contact the Finance Department when they receive an invoice.
List A: Acceptable documents that can be used as proof of identity (Obtain 1)
- A British passport
- An EEA / Swiss passport or national identity card.
- A Registration Certificate or Document Certifying Permanent Residence issued by the Home Office to an EEA / Swiss national.
- A Permanent Residence Card issued by the Home Office to the family member of an EEA / Swiss national.
- A passport endorsed to show, or a Biometric Residence Permit or Immigration Status Document showing, that the holder is exempt from immigration control, is allowed to stay indefinitely in the UK, has the right of abode in the UK, or has no time limit on their stay in the UK.
- A current Residence Card issued by the Home Office to the family member of an EEA / Swiss national.
- A current passport endorsed to show, or a Biometric Residence Permit or Immigration Status Document showing, that the holder has valid time limited permission to stay in the UK.
- A full UK birth or adoption certificate.
- A Naturalisation or Registration Certificate as a British Citizen.
List B: Acceptable documents that can be used as proof of address (Obtain 1)
- A valid full or provisional UK Driving Licence, confirming address.
- Utility bill (gas, electric, water, telephone) issued within the last 3 months, confirming address.
- Council tax bill issued within the last 12 months, confirming address.
- Current mortgage statement, confirming address.
- Current Tenancy agreement or rent book, confirming address.
- An official document confirming permanent National Insurance Number issued by a UK Government agency, or an employer, issued within the last 12 months, confirming address.
- Bank statement or passbook issued or updated in the last 3 months, confirming address.
- A letter from a UK Government agency issued within the last 3 months, confirming address.